Demographics, circumstances, toxicology and major organ pathology

Marijuana, Mental Illness, and Violence

Pills will kill, but testing them is not yet the answer

But it won’t work and is fraught with dangers. What if we don’t know what we are testing for? New psychoactive compounds are being developed all the time. In any case, is the drug we’re testing for consistent throughout the pill? We could easily miss it by scraping a little from the surface. And perhaps the deadly threat lurks in ­unidentified contaminants.

There is much to be considered — maybe first is the fact no forensic toxicologist I know recommends pill testing or believes it is practical.

Fitzgerald states the risks of pill testing appear to be minimal. That is curious. In a ­recent toxicology publication, a leading forensic scientist reported there was great concern in the US that these novel illicit substances typically are outside the scope of routine drug testing by hospitals and laboratories or below the sensitivity levels for detection. If major forensic facilities have difficulty in identifying these subs­tances, it stands to reason that on-site pill testing could not adequately identify most of the potentially lethal components in a pill scraping.

In another recent publication, Australian forensic laboratories noted there were about 740 new psychoactive substances ­reported to the UN Office on Drugs and Crime from 2009 to 2016.

Again, leading Australian forensic institutions using high-resolution mass spectrometry struggle to keep up with ever-increasing variations in synthetic substances. Pill testing may identify some of these within the time and scope of the on-site facility, but the risk of an adverse or fatal episode ­remains with several hundred substances not detected.

Fitzgerald reckons there is a strong case from more than two decades of experience in Europe, but that’s ignoring the exponential increase in deadly adulterants.

The issue of pill testing should be decided on forensic science. The ability to identify a wide range of components in a compound ­depends on the ability to test a ­representative portion of the substances, and that representation is incumbent on the pill being ­homo­geneously mixed when produced. If the pill has not been manufactured to ethical pharmaceutical standards then there is a risk of the pill tester missing the more toxic ingredients of the substances.

If pill testing were trialled, you would need sophisticated instrumentation such as high-resolution mass spectrometry to rapidly analyse the contents of the unknown substance. Such instrumentation is not amenable to on-site music festival venues. Crit­ically, operators of the instru­mentation would need to ensure their database of compounds is up to date. As newer synthetic drugs are regularly ­entering the market, forensic laboratories are struggling to obtain appropriate and ­expensive analytical reference material to identify unequivocally all ingredients in a pill.

To date, analytically trained ­experts have yet to explain ade­quately ­the complexity of attempting to test pills reliably and quickly at an on-site venue to be reasonably confident they can eliminate minute amounts of ­potentially lethal ingredients such as the deadly carfentanil.

Before moving ahead with a policy to trial pill testing, we need some sobering facts. The efficacy of pill testing is best left to forensic scientists, while the value of pill testing as a means of harm ­reduction is the domain of ­researchers into behavioural patterns of users and their potential for risk-taking. A 2004 study by the National Drug and Alcohol Research Centre into risk factors and risk perceptions found that those who perceived the possibility of getting caught or being ­involved in accidents were less likely to drive while impaired. Conversely, the perception of not getting caught or having an ­adverse reaction contri­buted to their drug-taking behav­iour..

John Lewis is honorary associate at the Centre for Forensic Science at the University of Technology Sydney

New drug MDPV or ‘monkey dust’, found in Australia. What is it and what are the harms?

What does MDPV do?

An oral dose of MDPV is estimated to be around 5-20 milligrams (compared to 100-150 milligrams for MDMA). The main psychoactive effects last two to three hours, and side-effects persist for several additional hours.

Side-effects, particularly at high doses, can include anxiety and paranoia, delusions, muscle spasms, and an elevated heart rate. In extreme cases, MDPV has been linked to rhabdomyolysis (rapid muscle breakdown), brain injury, and death.

Like other cathinones, MDPV is a stimulant and shares some effects with other stimulants such as amphetamine, cocaine and MDMA. MDPV produces its effects by inhibiting the reuptake of two important signalling molecules (neurotransmitters) in the brain; norepinephrine and dopamine.

Norepinephine is generally responsible for preparing the brain and body for action in the so-called “fight or flight response”, while dopamine is involved in more complex functions such as arousal, motivation, reward and motor control.

By blocking the ability of certain brain cells (neurons) to reabsorb these neurotransmitters, MDPV effectively increases the intensity and duration of norepinephrine and dopamine signalling. Cocaine works in a similar way, but in a lab test, MDPV was a much more potent inhibitor than cocaine.

Other norepinephrine-dopamine reuptake inhibitors (NDRIs) include pharmaceuticals such as methylphenidate (known as ritalin and used to treat ADHD) and buproprion (an antidepressant). But the psychoactive and stimulant effects of MDPV are much stronger than pharmaceutical NDRIs.

Pyrovalerone – a hybrid of mephedrone and MDPV – is an approved appetite suppressant used medically for weight loss. However, it’s rarely used due to its potential for abuse.

Studies in laboratory animals highlight the stimulating effects of MDPV, and also its potential for dependence. Mice trained to identify MDPV find it similar to both MDMA and methamphetamine. MDPV stimulates movement in rats approximately ten times more potently than cocaine, and rats will readily self-administer MDPV, suggesting it’s addictive.

But many of these deaths involved extreme doses, repeated dosing (“bingeing”), intravenous use or additional drugs. In fatal cases involving a single synthetic cathinone, death has been attributed to complications arising from extremely high body temperatures or damage to the vessels of the heart. Fortunately, specialised drug testing can detect MDPV and its derivatives.